Crisis Intervention in Situations Related to
Unsupervised Use of Psychedelics
Stanislav Grof, M.D.
Appendix I., LSD Psychotherapy: Hunter House Publishers, Alameda California.
©1980, 1994 by Stanislav Grof, M.D.
Since the mid-sixties, when experimentation with LSD and other
psychedelics moved from psychiatric institutes and clinics to
private homes and public places the role of mental health professionals
in regard to these substances has been drastically redefined.
Instead of being in the forefront as experimenters and researchers
they have become the rescuers and undertakers called upon to deal
with the casualties of the psychedelic scene. This development
has contributed considerably to the present attitudes of most
professionals toward these drugs; the primary focus of psychiatrists
and psychologists has shifted from the therapeutic potential of
psychedelics to their dangers. In the highly emotional atmosphere
created by sensational publicity, professionals have allowed their
image of LSD to be shaped by journalists and newspaper headlines
rather than scientific data generated by research. Consequently,
the casualties and complications of unsupervised experimentation
with LSD, instead of being attributed to irresponsible and ignorant
use, have been interpreted as reflecting dangers inherent in the
drug itself.
Restrictive legislation has practically destroyed scientific research
of psychedelic substances, but has not been very effective in
curbing unsupervised experimentation. While samples of psychedelic
drugs of doubtful quality are readily available in the streets
and on college campuses, it is nearly impossible for a serious
researcher to get a license for scientific investigation of their
effects. As a result of this, professionals are in a very paradoxical
situation: they are expected to give expert help in an area in
which they are not allowed to conduct research and generate new
scientific information. The widespread use of psychedelics and
relatively high incidence of drug-related problems are in sharp
contrast to the lack of understanding of the phenomena involved;
this is true for the general public as well as the majority of
mental health professionals.
This situation has very serious practical consequences. Various
emergencies associated with psychedelic drug use are handled in
a way that is at best ineffective, but more likely counter-productive
and harmful. Crisis intervention in psychedelic sessions and treatment
of the long-term adverse effects of unsupervised self-experimentation
are issues of such medical and social relevance that they deserve
special attention. Much of the information that is essential for
understanding the problems involved and for an effective approach
to this area has been presented in various sections of this book.
However, because of the importance of the problem I will briefly
review the most pertinent data here and apply them to the area
in question.
THE NATURE AND DYNAMICS OF PSYCHEDELIC CRISES
Understanding the dynamics of psychedelic experiences is absolutely
necessary for effective crisis intervention. A difficult LSD experience,
unless it results from a gross abuse of the individual, represents
an exteriorization of a potentially pathogenic matrix in the subject's
unconscious. If properly handled, a psychedelic crisis has great
positive potential and can result in a profound personality transformation.
Conversely, an insensitive and ignorant approach can cause psychological
damage and lead to chronic psychotic states and years of psychiatric
hospitalization.
Before discussing the difficult experiences that occur in psychedelic
sessions, their causes, and the principles of crisis intervention,
we will summarize our previous discussions about the nature and
basic dynamics of the LSD process. LSD does not produce a drug-specific
state with certain stereotypical characteristics; it can best
be described as a catalyst or amplifier of mental processes that
mediates access to hidden recesses of the human mind. As such,
it activates deep repositories of unconscious material and brings
their content to the surface, making it available for direct experience.
A person taking the drug will not experience an "LSD state"
but a fantastic journey into his or her own mind. All the phenomena
encountered during this journey—images, emotions, thoughts and
psychosomatic processes—should thus be seen as manifestations
of latent capacities in the experient's psyche rather than symptoms
of "toxic psychosis." In the LSD state the sensitivity
to external factors and circumstances is intensified to a great
degree. These extrapharmacological influences involve all the
factors usually referred to as ' set and setting': the subject's
understanding of the effects of the drug and purpose of ingestion,
their general approach to the experience, and the physical and
interpersonal elements of the situation. A difficult LSD experience
thus reflects either a pathogenic constellation in the experient's
unconscious, traumatic circumstances, or a combination of the
two.
Ideal conditions for an LSD session involve a simple, safe and
beautiful physical environment and an interpersonal situation
that is supportive, reassuring and nourishing. Under these circumstances,
when disturbing external stimuli are absent, negative LSD experiences
can be seen as psychological work on the traumatic areas of one's
unconscious. It is essential for the good outcome of an LSD session
to keep it internalized and fully experience and express everything
that is emerging. Psychedelic sessions in which the subject does
not stay with the process tend to create a dysbalance in the basic
dynamics of the unconscious. The defense system is weakened by
the effect of the drug, but the unconscious material that has
been released is not adequately worked through and integrated.
Such sessions are conducive to prolonged reactions or to subsequent
"flashbacks."
The only way to facilitate the completion and integration of an
LSD session in which the experiential gestalt remains unfinished
is to continue the uncovering work, with or without psychedelics.
It is important to emphasize that the effect of LSD is essentially
self-limited; the overwhelming majority of difficult psychedelic
experiences reach a resolution quite spontaneously. Actually,
those states that are most dramatic and stormy tend to have the
best outcome. The use of tranquilizers in the middle of a psychedelic
session is a grave error and may be harmful. It tends to prevent
the natural resolution of the difficult emotional or psychosomatic
gestalt and to "freeze" the experience in a negative
phase. The only constructive approach is to provide basic protection
to the subject, and support and facilitate the process; the least
one can do is to not interfere with it.
After this brief introduction, we can return to the problem of
complications during unsupervised psychedelic experimentation.
Although the basic principles discovered during clinical research
with LSD are directly applicable to crisis intervention, it is
important to emphasize the basic differences between the two situations.
The LSD administered in clinical and laboratory research is pharmaceutically
pure and its quality can be accurately gauged; most black market
samples do not meet these criteria. Only a small fraction of a
"street acid" specimen is relatively pure LSD; the black
market preparations frequently contain various impurities or admixtures
of other drugs. In some of the street samples that have been analyzed
in laboratories, researchers have detected amphetamines, STP,
PCP, strychnine, benactyzine, and even traces of urine. There
have been instances where alleged LSD samples contained some combination
of the above substances and no LSD whatsoever. The poor quality
of many of the street specimens is certainly responsible for some
of the adverse reactions that occur in the context of unsupervised
self-experimentation. In addition, uncertainty about quality and
dosage and the resulting fears can have a negative influence on
the ability of the subject to tolerate unpleasant experiences,
which are then readily interpreted as signs of toxicity or overdose
rather than manifestations of the users' unconscious.
However, the quality of drug and the uncertainty about it seem
to be responsible for a relatively small fraction of the adverse
reactions to LSD. There is no doubt that extrapharmacological
elements, such as the personality of the subject and the set and
setting, are by far the most important factors.
In order to understand the frequency and seriousness of psychedelic
crises that occur in the context of unsupervised self-experimentation,
it is important to take into consideration the circumstances under
which many people tend to take LSD. Some of them are given the
drug without any prior information about it, without adequate
preparation, and sometimes even without forewarning. The general
understanding of the effects of LSD is poor, even among experienced
users. Many of them take LSD for entertainment and have no provisions
in their conceptual framework for painful, frightening and disorganizing
experiences. Unsupervised experimentation frequently takes place
in complex and confusing physical and interpersonal settings that
can contribute many important traumatic elements. The hectic atmosphere
of large cities, busy highways in the rush hour, crowded rock
concerts or discos, and noisy social gatherings are certainly
not settings conducive to productive self-exploration and safe
confrontation with the difficult aspects of one's unconscious.
Personal support and a relationship of trust are absolutely crucial
for a safe and successful LSD session, and these are seldom available
under these circumstances. Not infrequently the person under the
influence of LSD is surrounded by total strangers. In some other
instances good friends may be present, but they are themselves
under the influence of the drug or are unable to tolerate and
handle intense and dramatic emotional experiences. When a group
of people take LSD together, the painful experiences of one person
can create a negative atmosphere which contaminates the sessions
of others. There have even been episodes in which persons who
took LSD or were given the drug were, for a variety of reasons,
exposed to deliberate psychological abuse. It is easy to understand
that such toxic circumstances are highly conducive to adverse
reactions.
PROFESSIONAL CRISIS INTERVENTION AND THE SELF-HELP APPROACHES
The present intervention offered by professionals in psychedelic
crises is based on the medical model and usually creates more
problems than it solves. The steps typically taken under these
circumstances reflect a serious lack of understanding of the nature
of the psychedelic experience, and are conducive to long-term
complications. This is further complicated by the numerous demands
on the time of a mental health practitioner and a lack of adequate
facilities for handling casualties from the psychedelic scene.
The tranquilizers that are routinely administered under these
circumstances tend to prevent effective resolution of the underlying
conflict and thus contribute to the incidence of chronic emotional
and psychosomatic difficulties after the session. Instant transfer
of the individual to a psychiatric facility in the middle of the
LSD experience is not only unnecessary, but represents a dangerous
and harmful practice. It disregards the fact that the LSD state
is self-limiting; in most instances, a dramatic negative experience
if properly handled will result in a beneficial resolution and
the subject will not need any further treatment. The "emergency
transfer" to a psychiatric facility, particularly if it involves
an ambulance, creates an atmosphere of danger and urgency that
contributes considerable additional trauma for a person who is
already extremely sensitized by the psychedelic state and the
painful emotional crisis. The same is true of the admission procedure
in the psychiatric facility and the atmosphere of the locked ward
which is the final destination of many psychedelic casualties.
Exposure to the routines of the psychiatric machinery while under
the influence of LSD can cause a life-long trauma. The fact that
psychiatric diagnosis and hospitalization may often represent
a serious social stigma is another important factor to consider
before proceeding with an unnecessary transfer and admission.
Moreover, if the LSD process does not reach a satisfactory resolution,
contemporary psychiatric care applies continued medication with
tranquilizers instead of the uncovering therapy that is the preferred
treatment under these circumstances.
The basic points of the above discussion can be illustrated with
the following example:
When I was working in the Psychiatric Research Institute in Prague,
Czechoslovakia, I was asked as consultant to see two employees
of the pharmaceutical laboratories that were involved in the production
of LSD. They had both suffered delayed adverse effects of an accidental
intoxication with LSD, while synthesizing the drug. One of them,
a man in his forties who was heading the department, showed symptoms
of deep depression with occasional bouts of anxiety, a sense of
meaninglessness of existence, and doubts about his sanity. He
dated these symptoms to the time of his intoxication with LSD
and subsequent brief hospitalization in a psychiatric facility.
His assistant, a woman in her twenties who had experienced accidental
intoxication with LSD several months after he did, complained
about bizarre sensations in her scalp; she was convinced that
she was rapidly losing her hair, although there were no objective
signs to support this.
During the diagnostic interviews with them I tried to reconstruct
the circumstances of their LSD experiences and the dynamics of
the problems they presented. The story that I heard, although
unbelievable of LSD therapists or people familiar with the nature
of psychedelic states, is unfortunately a typical example of crisis
intervention based on the conventional medical and psychiatric
models. The pharmaceutical laboratories that were involved in
the production of LSD were situated approximately two hundred
miles from Prague, where most of the clinical and laboratory research
with psychedelics was happening at that time. When the management
received the order to start the synthesis of Czechoslovakian LSD,
it was felt that, because of the nature of the substance, the
staff should be informed about its effects and instructed about
the necessary measures in case of accidental intoxication. The
director invited from the nearby state mental hospital a psychiatrist
who had no personal or professional experience of LSD and prepared
himself by reading a few papers on the-model psychosis"
approach to schizophrenia. During the seminar with the staff,
this superficially informed psychiatrist managed to paint an apocalyptic
picture of LSD. He told them that this colorless, odorless and
tasteless substance could insidiously enter their system, as had
happened to Dr. Albert Hofmann, and induce a state of schizophrenia.
He suggested that they should keep a supply of Thorazine in their
first-aid kit and in case of accidental intoxication bring the
tranquilized victim without delay to the psychiatric hospital.
As a result of these instructions, both laboratory workers received
Thorazine shortly after they had started to feel the effects of
the drug, and were rushed in an ambulance to the locked ward of
the state mental hospital. There they spent the rest of the intoxication
period and a few following days in the company of psychotic patients.
While under the influence of the LSD-Thorazine combination, the
department chief witnessed several grand mal seizures and had
a long discussion with a patient who was showing him his wounds
after a suicide attempt. The fact that he was put by mental health
experts in the company of severely disturbed patients contributed
considerably to his fear that he might himself be developing a
similar condition. Analysis of his LSD state, which was only incompletely
truncated by the Thorazine medication, showed that he was experiencing
elements of BPM II,*
and the confinement in the locked ward and his adventures there
represented a powerful reinforcement of his desperate state.
The experience of his research assistant was more superficial;
her reaction to the atmosphere of the locked ward was to pull
herself together and maintain control at any cost. Retrospective
analysis of her experience showed that she was approaching a traumatic
childhood memory, but because of the external circumstances she
suppressed it and prevented it from surfacing. Her feeling of
losing her hair turned out to be a symptom related to this deep
psychological regression; the infantile body image corresponding
to the age when she experienced the traumatic event involved hairlessness
as a natural condition.
During their visit to the Psychiatric Research Institute in Prague
these two pharmaceutical workers were able not only to work on
their symptoms, but also to change their image of LSD and the
negative feelings associated with it. We explained to them the
nature of the LSD state and discussed with them our therapeutic
program and the principles of conducting sessions. Before they
left they had ample opportunity to discuss the effects of LSD
with patients undergoing psycholytic treatment who had experienced
their sessions under substantially different circumstances. I
assured them that there was no reason for alarm if someone was
intoxicated by LSD; as a matter of fact, we were producing situations
like that routinely in our program. They were advised to have
a special, quiet room where the intoxicated individual could spend
the rest of the day listening to music in the company of a good
friend.
Several months later, I received a call from the department chief.
He told me that they had had another "accident"; a nineteen-year-old
laboratory assistant had experienced a professional intoxication.
She spent the day in a comfortable room adjacent to her laboratory
in the company of her friend and "had the time of her life."
She found her experience very pleasant, interesting and beneficial.
The avoidance techniques developed by the self-help movement,
although less harmful than the approach based on the medical and
psychiatric model, are also counterproductive. Attempts to engage
the subject in superficial conversations ("talking them down"),
to distract them by showing them flowers and beautiful pictures,
or taking them for a walk does not solve the underlying problem.
This can be seen at best as playing for time—keeping the individual
occupied with distracting maneuvers until the crisis subsides
or diminishes with the waning of the pharmacological effect of
the drug. These approaches are based on the erroneous assumption
that the drug has created the problem. Once we realize that we
are dealing with the dynamics of the unconscious, not a pharmacological
state, the short-sightedness of this approach becomes obvious.
The danger in using techniques that encourage avoidance lies in
the failure to confront and resolve the unconscious material that
underlies the emotional and psychosomatic crisis. LSD sessions
in which the emerging gestalt is not completed are conducive to
prolonged reactions, negative emotional and physical aftereffects,
and "flashbacks".
COMPREHENSIVE CRISIS INTERVENTION IN PSYCHEDELIC EMERGENCIES
Having discussed the factors that contribute to the development
of emergencies in unsupervised LSD sessions and described the
harmful practices that characterize most professional and lay
interventions, I would like to outline what I consider the optimal
approach to psychedelic crises, based on the understanding of
their dynamics. What constitutes an emergency in an LSD session
is highly relative and depends on a variety of factors. It reflects
an interplay between the subject's own feelings about the experience,
the opinions and tolerance of the people present, and the judgment
of the professional called upon to offer help. This last is a
factor of critical importance; it depends upon the therapist's
degree of understanding of the processes involved, his or her
clinical experience with unusual states of consciousness, and
his or her freedom from anxiety. In psychedelic crisis intervention,
as in psychiatric practice in general, drastic measures frequently
reflect the helpers' own feelings of threat and insecurity, not
only vis à vis possible external danger, but also in relation
to their own unconscious. The experience from LSD therapy and
the new experiential psychotherapies clearly indicates that exposure
to another person's deep emotional material tends to shatter psychological
defenses and to activate corresponding areas in the unconscious
of the persons assisting and witnessing the process, unless they
have confronted and worked through these levels in themselves.
Since traditional psychotherapies are limited to work on biographical
material, even a professional with full training in analysis is
inadequately prepared to deal with powerful experiences of a perinatal
and transpersonal nature. The prevailing tendency to put all such
experiences into the category of schizophrenia and suppress them
in every way reflects not only a lack of understanding, but also
a convenient self-defense against the helpers' own unconscious
material.
As the sophistication and clinical experience of LSD therapists
has increased, it has become more and more evident that negative
episodes in psychedelic sessions should not be seen as unpredictable
accidents, but intrinsic and lawful aspects of the therapeutic
work with traumatic unconscious material. From this point of view
the colloquial term "bummer" or "bad trip"
does not make sense. To an experienced LSD therapist an unsuccessful
psychedelic session is not one in which the subject experiences
panic anxiety, self-destructive tendencies, abysmal guilt, loss
of control, or difficult physical sensations. If properly handled,
a painful and difficult LSD session can bring about an important
therapeutic breakthrough. It can facilitate resolution of problems
that have plagued the subject in subtle ways for many years and
contaminated his or her everyday life. An unsuccessful session,
however, is one in which difficult feelings begin to emerge, the
subject does not fully surrender to the process and the gestalt
remains unresolved. From this point of view, all psychedelic experiences
in which the process is thwarted by the administration of tranquilizers
and external distractions such as transfer to a psychiatric hospital
are not failures because of the nature of the psychological process
involved, but because the crisis management has interfered with
a positive resolution.
Although LSD can induce difficult experiences even under the best
circumstances, it would be a mistake to attribute all "bad
trips" to the drug itself. The psychedelic state is determined
by a variety of non-drug factors; the incidence of serious complications
depends critically on the personality of the subject, and the
elements of set and setting. This can be illustrated by comparing
the incidence of complications during the early supervised experimentation
with LSD, and the psychedelic scene of the sixties. In 1960, Sidney
Cohen published a paper entitled, LSD: Side Effects and Complications.
J. Nerv. Ment. Dis. 130:30, 1960. It was based on reports
from forty-four professionals who had administered LSD and mescaline
to about five thousand persons over twenty-five thousand times;
the number of sessions per person ranging between one and eighty.
In the group of normal volunteers, the incidence of attempted
suicides after the session was less than one in a thousand cases,
and that of prolonged reactions lasting over forty-eight hours
was 0.8 per thousand. The numbers were somewhat higher when psychiatric
patients were used as subjects; in every thousand patients there
were 1.2 suicide attempts, 0.4 completed suicides and 1.8 prolonged
reactions lasting over forty-eight hours. In comparison with other
methods of psychiatric therapy, therefore, LSD appeared to be
unusually safe, particularly when contrasted with other procedures
used routinely in psychiatric treatment at that time, such as
electroshocks, insulin comas, and psychosurgery. These statistics
contrast sharply with the incidence of adverse reactions and complications
associated with unsupervised experimentation. During my visit
to the Haight-Ashbury clinic in San Francisco in the late sixties,
I was told by its director David Smith that they were treating
an average of fifteen "bad trips" a day. Although this
does not necessarily mean that all these clients had long-lasting
adverse effects from their psychedelic experiences, it illustrates
the issue in question.
The experience and sophistication of psychiatrists and psychologists
in relation to psychedelics was certainly not great during the
early years and the settings were far from ideal. However, the
sessions reported in Dr. Cohen's paper were conducted in protected
environments, under reasonable supervision and by responsible
individuals. In addition, those who had difficult experiences
were in a place that was equipped to provide help in case of need
and they did not have to be subjected to the absurd ordeal of
transfer to a psychiatric facility.
The psychedelic crisis is caused by a complicated interplay of
internal and external factors. The therapist has to distinguish
which of the two sets of influences is more important and proceed
accordingly. The first and most important step in handling a psychedelic
crisis is to create a simple, safe and supportive physical and
interpersonal environment for the subject. In cases where external
factors seem to have played a crucial role, it is important to
remove the individual from the traumatic situation or change it
by active intervention. If the crisis occurred in a public locale,
he or she should to be taken to a quiet, secluded place. If the
incident happens during a party in a private residence, it is
important to simplify the situation by moving to a separate room
or asking the guests to leave. A few close friends who appear
sensitive and mature may be asked to assist in the process. They
can provide group support or help the subject to actively work
through the underlying problem during the termination period of
the session. The techniques of group involvement in psychedelic
sessions have been discussed earlier in this book (p. 145).
After creating a safe environment the next important task is to
establish good contact with the subject. A relationship of trust
is probably the most significant prerequisite for the positive
outcome of a psychedelic session in general and for successful
handling of a crisis in particular. A person asked to intervene
in a crisis triggered by LSD is at a great disadvantage as compared
to an LSD therapist facing a similar situation in the course of
psychedelic treatment, because the therapeutic session is preceded
by a drug-free preparation period during which there is enough
time to establish good contact and a relationship of trust. If
a difficult situation arises in the course of an LSD series, the
client can also draw on his or her memories of previous sessions
where painful experiences had been successfully worked through
and integrated with the help of the therapist.
In contrast, the professional dealing with a crisis outside of
the therapeutic context walks into the emergency situation as
a stranger, usually without any previous contact with the subject
and other persons involved. Trust and cooperation have to be established
in a very short time and often under dramatic circumstances. Freedom
from anxiety, an ability to remain centered, deep empathy, and
intimate knowledge of the dynamics of psychedelic states are the
only means of generating trust under these circumstances.
It is essential to convey a sense of safety and security by emphasizing
the self-limiting nature of the LSD experience. No matter how
critical the condition appears to be, in most instances it will
be resolved spontaneously five to eight hours after the ingestion
of the drug. This time limit should be clearly communicated to
the subject and other people present; until that time there is
absolutely no reason to panic or worry, however dramatic the emotional
and psychosomatic manifestations might be. It is also of great
advantage to keep the subject in a reclining position, but this
should be attained without using physical force and open restraint.
With a little experience, one can develop a technique with which
it is possible to effectively restrain the individual using a
context of support and cooperation rather than conflict.
When adequate contact has been established, a positive framework
should be offered for the difficult LSD experience. It is essential
to present it as an opportunity to face and work through certain
traumatic aspects of one's unconscious rather than as an unfortunate
and tragic accident. A person assisting in a psychedelic crisis
should make consistent attempts to internalize the experience
of the LSD subject and encourage him or her to face the critical
issues involved. The LSD subject should be encouraged to keep
his or her eyes closed and confront the experience, whatever it
is. The therapist should repeatedly communicate to the subject
that the quickest way out of this difficult state is through surrendering
to the emotional and physical pain, experiencing it fully and
finding appropriate channels to express it. This process of surrendering
can be greatly facilitated by music. If a good high-fidelity stereo
set is available, and the subject is open to it, music should
be introduced into the situation as soon as possible.
When good rapport has been established, it is possible to offer
active assistance using comforting physical contact, elements
of playful struggle, and pressure on or massage of the parts of
the body where the energy appears to be blocked. This should not
be done if the trust bond is precarious or absent; it is absolutely
contraindicated if the subject is paranoid and includes the people
present among his or her persecutors. In some instances simply
being with the client and playing for time might be the only solution.
Under such circumstances, it is essential to use any possible
means and existing resources to keep the LSD subject from hurting
himself or others and causing serious material damage. While following
this basic rule, occasional attempts should be made to establish
rapport and gain the individual's cooperation.
If the gestalt of the experience remains unfinished when the effect
of the drug is subsiding, psychological and physical activity
should be used to facilitate integration. Ideally, the subject
should complete the session feeling comfortable and relaxed, without
any residual emotional or psychosomatic symptoms. The two techniques
that have proven useful in this context—the abreactive approach
and the cleansing hyperventilation—have been discussed earlier
in this book (pp. 144-5, 147-8). After the subject reaches a psychologically
and physically comfortable state, it is important to create a
safe and nourishing atmosphere for the rest of the day and night.
Ideally, a person who has been through a psychedelic crisis should
not be left alone for at least twenty-four hours after the ingestion
of the drug. After this time the therapist should see the client
again, reevaluate the situation and, depending on his or her condition,
choose the future strategy. In most instances no further provisions
are necessary if the crisis was properly handled. It is useful
to discuss the LSD experience in detail and facilitate its integration
into the client's everyday life. If significant emotional and
psychosomatic complaints have appeared as a result of the LSD
experience, arrangements should be made for follow-up uncovering
therapy and body work. An individualized selection of meditation
techniques, Gestalt practice, neo-Reichian approaches, guided
imagery with music, controlled breathing, polarity massage or
rolfing should be offered to the client.
Where the clinical condition remains precarious despite all the
uncovering work, this treatment may have to be continued on an
in-patient basis. If all the above approaches prove ineffective,
integration can be facilitated by chemical means. Ideally, a supervised
psychedelic session should be scheduled after adequate preparation.
This approach might seem paradoxical to the average mental health
professional, since it involves administration of the same drug
or category of drugs that apparently brought the client trouble
in the first place. Yet judicious use of psychedelics under these
circumstances is the preferred treatment. Clinical experiences
have shown that it is extremely difficult to restore defenses
by the use of covering techniques such as tranquilizers, once
the unconscious has been opened by a powerful psychedelic substance.
It is much easier to continue the uncovering strategy and facilitate
completion of the unfinished gestalt.
Psilocybin, methylene-dioxy-amphetamine (MDA), tetrahydrocannabinol
(THC), and dipropyltryptamine (DPT) are viable alternatives to
LSD. They have the same general effects and are less contaminated
by bad publicity. MDA and THC seem to be particularly useful in
this context, because of their gentle effect and selective affinity
to positive governing systems in the unconscious. Effective psychological
work with these substances involves less emotional and psychosomatic
pain than when LSD is used.
Since the above psychedelics are not readily available, and obtaining
permission to use them involves tedious administrative procedures,
a session with Ritaline (100-200 milligrams) or Ketalar (100-150
milligrams) might be a more feasible approach. Tranquilizers should
not be used in any condition related to the use of psychedelic
drugs until all the above uncovering approaches have been tried
and have failed.
Powerful non-drug approaches could also be used in lieu of tranquilizers
in all those cases where a poorly resolved LSD experience results
in a long-term psychotic condition and psychiatric hospitalization
lasting months or years. If these do not bring about sufficient
clinical improvement, psychedelic therapy, using the substances
mentioned above, is the next logical choice. Ketalar, a drug that
is legally available and has been used in a medical context for
general anesthesia could prove promising in these otherwise desperate
cases.
I would like to conclude this discussion of psychedelic crisis
intervention with a description of the most dramatic situation
of this kind I have encountered in my professional career.
In my third year in Big Sur, California, I was awakened at 4:30
one morning by a telephone call. It was the night guard from the
nearby Esalen Institute asking for help. A young couple called
Peter and Laura, who were traveling down the coast, had parked
their VW camper on coastal route 1 in the vicinity of the Esalen
Institute and had decided to take LSD together. They rolled out
the bed in their car and shortly after midnight both of them ingested
the drug. Laura-s experience was relatively smooth, but Peter
progressively developed an acute psychotic state. He became paranoid
and violent, and after a period of verbal aggression he started
throwing things around and demolishing the car. At this point
Laura panicked, locked him in the car and sought help at Esalen.
She appeared at the guard shack completely naked, holding the
car keys in her hand. The night guard knew about my previous work
with psychedelics and decided to give me a call; he also woke
up Rick Tarnas, a resident psychologist who had done his dissertation
on psychedelic drugs.
While the guard was taking care of Laura, who calmed down and
had a pleasant, uncomplicated LSD experience, Rick and I walked
to the camper. As we approached the car we heard loud noises and
shouting; when we came closer we noticed that several of the windows
were broken. We unlocked the car, opened the door and started
talking to Peter. We introduced ourselves and told him that we
had had considerable experience with psychedelic states and had
come to help him. I tentatively stuck my head inside the door
and looked into the camper; a half-gallon bottle missed me by
about four inches and landed on the dashboard. I repeated this
several times, and two more objects came flying in my direction.
When we felt that Peter had nothing more to throw, we quickly
moved into the camper and lay down on the roll-out bed on either
side of him.
We continued talking to Peter, reassuring him that everything
would be all right in an hour or two; knowing that he and his
girlfriend had taken LSD after midnight, we could give him this
definite time limit. It became obvious that he was in a paranoid
state and saw us as hostile FBI agents who had come to fetch him.
We held his arms in a comforting and reassuring way, changing
this into a firm grip whenever he made an attempt to escape, but
avoiding real physical antagonism and struggle. All the while,
we kept talking about having had difficult experiences ourselves,
and finding them retrospectively useful. His condition oscillated
for about an hour between mistrust with anxiety-laden aggressive
impulses, and episodes of relief when it was possible to connect
with him.
As time went by and the LSD state became less intense, Peter slowly
developed trust. He was more and more willing to keep his eyes
closed and face the experience, and we were even able to start
working carefully on the blocked parts of his body, encouraging
full emotional expression. By seven o'clock all negative elements
completely disappeared from Peter's LSD experience. He felt cleansed
and reborn, and was thoroughly enjoying the new day. His previous
hostility turned into deep gratitude and he kept repeating how
much he appreciated our intervention.
At about half-past-seven Laura appeared at the camper and joined
us; she was herself in very good condition, but was naturally
concerned about Peter. Rick and I helped dispel the negative aftermath
of the dramatic events of the night and facilitated their reunion.
We advised them strongly against driving that day. They spent
a leisurely day by the Pacific Ocean and the next day continued
their journey south. They were both in good spirits, although
somewhat worried about the bill for the repair of their damaged
camper.
Editor's Footnote
*Dr. Grof's theory of Basic Perinatal Matrices
is explained both in LSD Psychotherapy and Beyond the
Brain (back)